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Volume 33, Issue 1 (February 2013), pp. 23-31

Trends in child mortality: a prospective, population-based cohort study in a rural population in south-west Uganda

Author Affilations
*Corresponding author:
1National Centre in HIV Epidemiology and Clinical Research, Faculty of Medicine, University of New South Wales, Australia
2Medical Research Council/Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe, Uganda
3London School of Hygiene and Tropical Medicine, UK


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Background: Although there has been substantial global progress in decreasing child mortality over the past two decades, progress in sub-Saharan Africa has largely lagged behind. The temporal trends in child mortality and associated risk factors were investigated in a cohort of children in rural Uganda.

Methods: Information on children’s vital status, delivery, breastfeeding, vaccination history, maternal vital and HIV status, and children’s HIV status for 1993–2007 was retrieved from the Medical Research Council/Uganda Virus Research Institute’s (MRC/UVRI) Annual Population Census and Survey in Uganda. Regression models were employed to assess the association of these factors with child mortality.

Results: From 1993 to 2007, the death rate (/1000 person-years) in children <13 years of age decreased significantly from 16 to six. Apart from neonates, age-specific death rates fell in all age-groups. A reduction since 1999 in the risk of child mortality was associated with vaccination, birth in a health facility, exclusive breastfeeding for 6 months, 2–3 years since the previous sibling’s birth, maternal vital status, and negative mother and child HIV serostatus. Although HIV seropositive children had a 26-fold increased risk of death before 13 years of age, HIV prevalence in children was about 1% and so had a small overall impact on child mortality.

Conclusion: These findings are consistent with those of repeated national cross-sectional surveys. Meeting the Millennium Development Goals for child survival in sub-Saharan Africa depends on faster progress in implementing measures to improve birth-spacing, safe delivery in health facilities, infant feeding practices and vaccination coverage.

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Paediatrics and International Child Health is an international forum for all aspects of paediatrics and child health in developing and low-income countries. The international, peer-reviewed papers cover a wide range of diseases in childhood and examine the social and cultural settings in which they occur. Although the main aim is to enable authors in developing and low-income countries to publish internationally, it also accepts relevant papers from industrialised countries. The journal is a key publication for all with an interest in paediatric health in low-resource settings.

Accreditation for PCH cover images (images captioned from left to right along each line): (7) Boy receives physiotherapy for cystic fibrosis, – Veronica Birley; (8) Overwhelming measles in a child with kwashiorkor, – Brian Coulter; (10) Boy with polio, Tanzania, – Derek Charlwood; (11) Toddler girl with hypophosphataemic rickets, – Brian Coulter


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Assistant Editor:

Editorial Board:

  • Professor Stephen Allen (College of Medicine, Swansea University, Swansea, UK)
  • Professor Emmanuel Ameh (Division of Paediatric Surgery, Ahmadu Bello University & ABU Teaching Hospital, Zaria, Nigeria)
  • Dr Zulfiqar Bhutta (Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan)
  • Professor David Brewster (School of Medicine, University of Botswana, Gaborone, Botswana)
  • Associate Professor Pornthep Chanthavanich (Department of Tropical Pediatrics, Mahidol University, Bangkok, Thailand)
  • Professor Cheng-Hsun Chiu (Division of Pediatric Infectious Diseases, Chang Gung Children’s Hospital, Taoyuan, Taiwan)
  • Professor Richard W I Cooke (Neonatal Unit, Liverpool Women’s Hospital, Liverpool, UK)
  • Professor Adekunle Dawodu (Center for Global Child Health, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA)
  • Dr Jailson de Barros Correia (Department of Science & Technology, Ministry of Health, Brasilia, Brazil)
  • Professor Harendra de Silva (Department of Paediatrics, Faculty of Medicine, Ragama, Sri Lanka)
  • Professor Trevor Duke (Centre for International Child Health, University of Melbourne, Australia)
  • Dr Ricardo Queiroz Gurgel (Federal University of Sergipe, Aracaju, Brazil)
  • Professor Gregory Hussey (Department of Paediatrics & Child Health, University of Cape Town, Cape Town, South Africa)
  • Professor Patrick Kolsteren (Child Health & Nutrition Unit, Institute of Tropical Medicine, Antwerp, Belgium)
  • Professor Michael B Krawinkel (Institute of Nutritional Sciences, Justus-Liebig University, Giessen, Germany)
  • Dr Chewe Luo (HIV Section, UNICEF, New York, NY, USA)
  • Dr Sarah Macfarlane (Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA)
  • Professor Elizabeth Molyneux (Department of Paediatrics, College of Medicine, Blantyre, Malawi)
  • Professor Osamu Nakagomi (Department of Molecular Epidemiology & Masters Course in Tropical Medicine, Nagasaki University, Japan)
  • Professor Tony Nelson (Department of Paediatrics, The Chinese University of Hong Kong, People's Republic of China)
  • Professor Mohammed Ibrahim Ali Omer (Unit of Child Health, Eric Williams Medical Sciences Complex, Champs Fleurs, Trinidad & Tobago)
  • Professor Vinod Kumar Paul (Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India)
  • Dr Mohammed Abdus Salam (Clinical Sciences Division, ICDDR,B, Dhaka, Bangladesh)
  • Dr Ira Shah (Pediatric HIV Clinic, TB Clinic & Pediatric Liver Clinic, B J Wadia Hospital for Children, Mumbai, India)
  • Professor Chris Taylor (Academic Unit of Child Health, Sheffield Children’s Hospital, Sheffield, UK)
  • Professor James Tumwine (Department of Paediatrics & Child Health, Makerere University at Mulago Hospital & College of Health Sciences, Kampala, Uganda)
  • Professor Zhu-Wen Yi (Department of Pediatrics, Division of Nephrology, Children’s Medical Center, The Second Xiangya Hospital, Central South University, China) 

Paediatrics and International Child Health

Print ISSN: 2046-9047
Online ISSN: 2046-9055
Previously published as:
  • Annals of Tropical Paediatrics


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Lei Zhang1,2, Dermot Maher2, Mary Munyagwa2, Ivan Kasamba2, Jonathan Levin2, Samuel Biraro2, and Heiner Grosskurth3. "Trends in child mortality: a prospective, population-based cohort study in a rural population in south-west Uganda." Paediatrics and International Child Health 2013; 33(1), 23-31.

DOI: 10.1179/2046905512Y.0000000041

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